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MP 2.04.200 Drug Screen Testing

Medical Policy    
Section
Medicine
 
Original Policy Date
8/2013
Last Review Status/Date
Created with literature search/8:2013
Issue
8:2013
  Return to Medical Policy Index

Disclaimer

Our medical policies are designed for informational purposes only and are not an authorization, or an explanation of benefits, or a contract.  Receipt of benefits is subject to satisfaction of all terms and conditions of the coverage.  Medical technology is constantly changing, and we reserve the right to review and update our policies periodically. 


Description

Initial Screening Urine Drug Testing

The preferred method of initial urine drug testing when clinically appropriate is by utilization of a multidrug screening kit (qualitative analysis by multiplexed method for 2-15 drugs or drug classes). 

Drug screen testing may be appropriate for various reasons including:

  • Diagnosis of a medical condition where drug toxicity may be a contributing factor;
  • Diagnosis of possible exposure of fetus to illicit drugs taken by mother;
  • Assessment of patients for substance abuse treatment program during the Induction Phase to determine the patient’s drug profile and detoxification regime;
  • Assessment of patient’s adherence to the substance abuse treatment program during the stabilization phase of treatment;
  • Assessment of abstinence before initiating drug therapy known to produce withdrawal symptoms; and
  • Assessment and management of patients in chronic pain treatment programs. 

Screening as part of a drug abuse maintenance program may be excluded under the member contract. 

Point-of-care, office-based screening tests may be appropriate when necessary licensure has been obtained and test results directly affect patient care. 

Confirmatory Testing

The initial screening urine drug test combined with the clinical picture may suggest the need for secondary confirmatory testing in certain cases. This testing may use various techniques to provide detailed and sometimes qualitative information regarding the presence of a specific drug. Such testing may be considered medically necessary when certain criteria are met (See Policy section below). Testing should be directed to determine the presence of a specific drug or drug class based on the individual clinical picture. Confirmatory drug screen testing should not routinely include a panel of all drugs of abuse. When confirmatory testing is deemed medically necessary, it must be performed on either the same sample, or same-day sample, as the initial screening urine drug test. Frequency of testing should be at the lowest appropriate level (1).

When confirmatory testing is necessary, please utilize a Blue Cross of Idaho contracting laboratory facility. 


Policy

 

Qualitative urine drug screening may be considered medically necessary as indicated under the Initial Screening Urine Drug Testing section and when documentation supports the clinical impact of such testing. When necessary, this testing should be performed at the lowest appropriate frequency. Drug screening codes are eligible for reimbursement of one unit per date of service. 

 

The following points pertain to confirmatory or quantitative drug testing, not the initial screening urine drug test.

  • Confirmatory or quantitative testing may be considered medically necessary when documented clinical rationale supports the need for testing and its impact on treatment.  Such testing should be ordered in a drug-specific manner (eg. opiates in question rather than a comprehensive confirmatory panel).
  • Confirmatory or quantitative testing is considered not medically necessary, regardless of the initial screening urine drug test results, when documentation does not adequately support the clinical impact of such testing.
  • Confirmatory or quantitative testing is considered not medically necessary for positive confirmation of prescribed drugs when documentation does not adequately support the clinical impact of such testing.
  • Confirmatory or quantitative testing is considered not medically necessary when performed reflexively and routinely without supporting documented clinical rationale. 

Policy Guidelines

CMS Reference:   MLN Matters SE1105 Medicare Drug Screen Testing 

Drug screen testing codes are eligible for reimbursement of one unit per date of service for facilities and professional providers.   

  • G0431 – Drug screen, qualitative; multiple drug classes by high complexity test method (e.g., immunoassay, enzyme assay), per patient encounter
  • G0434 - Drug screen, other than chromatographic; any number of drug classes, by CLIA waived test or moderate complexity test, per patient encounter

The following codes are also billable with reimbursement based on one unit per patient encounter.

  • 80100 – Drug screen, qualitative; multiple drug classes chromatographic method, each procedure
  • 80101 - Drug screen, qualitative; single drug class method (eg, immunoassay, enzyme assay), each drug class
  • 80104 - Drug screen, qualitative; multiple drug classes other than chromatographic method, each procedure 

CPT codes 80100, 80101 and 80104 are not valid for Medicare Advantage members. 


References:

  1. Christo PJ, et al. Urine drug testing in chronic pain. Pain Physician. 2011 Mar-Apr;14(2): 123-143

Codes

Number

Description

CPT  G0431 Drug screen, qualitative; multiple drug classes by high complexity test method (e.g., immunoassay, enzyme assay), per patient encounter
  G0434 Drug screen, other than chromatographic; any number of drug classes, by CLIA waived test or moderate complexity test, per patient encounter
  80100

Drug screen, qualitative; multiple drug classes chromatographic method, each procedure

  80101 Drug screen, qualitative; single drug class method (eg, immunoassay, enzyme assay), each drug class 
  80104 Drug screen, qualitative; multiple drug classes other than chromatographic method, each procedure

 


Policy History

Date Action Reason
08/06/13 Add to Medicine section New policy